Endosc Int Open 2015; 03(01): E7-E13
DOI: 10.1055/s-0034-1377835
Original article
© Georg Thieme Verlag KG Stuttgart · New York

Sedation in gastrointestinal endoscopy: a prospective study comparing nonanesthesiologist-administered propofol and monitored anesthesia care

Gustavo Andrade de Paulo
1   Universidade Federal de São Paulo – Gastroenterology, São Paulo, Brazil
2   Hospital Albert Einstein – Endoscopy, São Paulo, Brazil
,
Fernanda P.B. Martins
2   Hospital Albert Einstein – Endoscopy, São Paulo, Brazil
,
Erika P. Macedo
2   Hospital Albert Einstein – Endoscopy, São Paulo, Brazil
,
Manoel Ernesto P. Gonçalves
2   Hospital Albert Einstein – Endoscopy, São Paulo, Brazil
,
Carlos Alberto Mourão
3   Universidade Federal de Juiz de Fora – Physiology, Juiz de Fora, Brazil
,
Angelo P. Ferrari
1   Universidade Federal de São Paulo – Gastroenterology, São Paulo, Brazil
2   Hospital Albert Einstein – Endoscopy, São Paulo, Brazil
› Author Affiliations
Further Information

Publication History

submitted 09 February 2014

accepted after revision 06 July 2014

Publication Date:
16 January 2015 (online)

Introduction: Adequate sedation is one of the cornerstones of good quality gastrointestinal endoscopy (GIE). Propofol sedation has increased significantly but there has been much debate over whether it can be administered by endoscopists. The aim of this prospective trial was to compare nonanesthesiologist-administered propofol (NAAP) and monitored anesthesia care (MAC).

Methods: A total of 2000 outpatients undergoing GIE at Hospital Albert Einstein (São Paulo, Brazil), a tertiary-care private hospital, were divided into two matched groups: NAAP (n = 1000) and MAC (n = 1000). In NAAP, propofol doses were determined by the endoscopist. A second physician stayed in the room during the entire procedure, according to local regulations. In MAC, the anesthesiologist administered propofol.

Results: In total, 1427 patients (71.3 %) were ASA (American Society of Anesthesiologists) class I and 573 were ASA class II. In NAAP, patients received more propofol + fentanyl (61.1 % vs. 50.5 %; P < 0.05) and there were fewer cases of deep sedation (44.7 % vs. 66.1 %; P < 0.05). Hypoxemia rates were similar (12.8 % for NAAP and 11.2 % for MAC; P = 0.3) but these reverted more rapidly in MAC (4.22 seconds vs. 7.26 seconds; P < 0.05). Agitation was more frequent in MAC (14.0 % vs. 5.6 %; P < 0.05). No later complications were observed. Patient satisfaction was very high and similar in both groups.

Conclusion: In this setting, NAAP was as safe and effective as MAC for healthy patients undergoing GIE.

Clinical trial ref. no.: U1111-1134-4430

 
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